Abstract 12569: Gender Differences in Patients’ Experiences of Discussions About and Attitudes Toward Replacement and Deactivation of Their ICD at End-of-Life

Abstract

Introduction: Gender disparities are well documented in cardiovascular care, and women are underrepresented in cardiovascular studies. Gender differences in experiences and attitudes toward replacement and deactivation of implantable cardioverter defibrillators (ICD) at the end-of-life (EOL) are less well studied. Purpose: To determine if there are gender differences in patients’ experiences of discussions about and attitudes toward replacement of their ICD at end-of-service and ICD deactivation at EOL. Methods: This cross-sectional study included 3,465 ICD recipients living in the United States, Australia, Ireland, Sweden, and South Korea (21% women with mean age 65 + 12). We used the experiences subscale (10 items) and attitudes subscale (18 item) of the EOL-ICD questionnaire. Chi-square test was used to explore potential differences in experiences of discussion and attitude toward ICD treatment at EOL by gender; differences between the scale single items were assessed. Results: Women were more likely than men to think about questions concerning EOL, X 2 (2, N = 3,444) = 34.1, p < .001). Women had more experience discussing battery replacement with their clinician ( p < .01) and next of kin ( p < .001), and ICD deactivation at EOL with their next of kin ( p = .01), but they were less likely to discuss their illness trajectory with their clinician ( p = .02)). There were no differences between women and men regarding the time they would like their clinician to start the conversation about ICD deactivation. Men were more reluctant than women to change their ICD battery or turn the device off even if they were dying of cancer or having daily shocks (( p < .001). Conclusion: Gender differences in patients’ attitude toward ICD treatment are evident. This might be related to many factors including prior experience of discussing EOL issues with their clinician. Further studies to explore the reasons for gender differences in patients’ experiences of discussions and attitude toward ICD treatment are warranted.